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2. Name of Nonprofit Group Receiving Funds
4. Address
6. City
7. State
8. Zip Code
10. Missouri Sales Tax ID Number (a copy must be attached)
12. Attach Sales Tax ID Number
14. Date(s) Collecting
16. Time(s) Collecting
    No collections allowed after dark.
18. Location
20. Contact Person
21. Phone Number
23. Additional Information
25. Safety Requirements
    For the safety of those collecting the following requirements must be met:
    1. One person must be designated to supervise the collection efforts, thus making them responsible for the safety of the collectors.
    2. All individuals collecting money are required to wear an orange/reflective vest.
27. Name of Person Collecting
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field